Poll Results: Top Interventional Trials of 2017
This poll asked users to rate the impact to their practices of selected, major trials in 2017. The trials and results are listed above; it's really a case of the good and the bad. Aortic valve treatment issues topped the list. SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) encouraged the potential use of transcatheter aortic valve replacement (TAVR) in moderate-risk patients. As data accumulate, interventionalists and patients seek data to assure safe aortic valve treatment without surgery. The reality check is SAVORY (Subclinical Aortic Valve Bioprosthesis Thrombosis Assessed With 4D CT), which documented local valve thrombus that could effect late outcomes; it stresses the fact that more studies are necessary to optimize TAVR outcome.
MR-INFORM (Stress Perfusion Imaging to Guide the Management of Patients With Stable Coronary Artery Disease) is the first study to show non-inferior outcomes in for revascularization guided by magnetic resonance (MR) screening for significant coronary artery disease compared with fractional flow reserve-guided coronary angiography. This is a potentially important opportunity to apply angiography to the most appropriate patients without first performing angiography. The results are limited by the lack of comparison to other noninvasive modalities such as computed tomography fractional flow reserve. But the message is out that documented coronary lesion severity is critical to treatment decisions, and MR is a now a "player."
SPYRAL HTN-OFF MED (Investigation of Catheter-Based Renal Denervation in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications) revives the potential for renal artery ablation as a treatment for hypertension. Methods of ablation remain a potential for investigation, and there is hope that this treatment could ease the medication burden for patients with hypertension.
CANTOS (Canakinumab Anti-Inflammatory Thrombosis Outcomes Study) became a proof of principle trial, demonstrating that reducing inflammation by means other than statins improves outcomes. As of this moment, it's not clear how this will be incorporated into clinical practice, but it is a major advance for treating high-risk coronary patients after an ischemic event. Extension of these results with further trails may magnify the impact on coronary disease management.
Interestingly, ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) was not in the top five. From my perspective, as I have previously written, longer-term follow-up will be critical to observe the true clockmaker impact.
Lastly, I was disappointed that STEMI ACCELERATOR-2 (Regional STEMI Systems of Care: Results of the Mission: Lifeline STEMI ACCELERATOR-2 Study) was ranked number nine. One would hope that strategies to improve acute intake management of STEMI was not ranked higher. As the study shows, there is a significant opportunity to improve outcomes by doing better what we think we do well now.
I have done my best to interpret the thoughts of our voters. Overall, the studies chosen reflect a continuing focus on structural, particularly focusing on TAVR, with the usual focus on "choosing wisely" in the management of ischemia with revascularization.
And the cycle continues. Hopefully 2018 will see an increase in refinement of many of these results. Thanks for participating.
Keywords: Coronary Angiography, Transcatheter Aortic Valve Replacement, Coronary Artery Disease, Aortic Valve, Antihypertensive Agents, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Angina, Stable, Renal Artery, Myocardial Infarction, Four-Dimensional Computed Tomography, Antibodies, Monoclonal, Heart Valve Prosthesis, Perfusion Imaging, Angioplasty, Thrombosis, Hypertension, Inflammation, Magnetic Resonance Spectroscopy, Percutaneous Coronary Intervention
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